|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$227.05
|
|
|
Service Code
|
NDC 904721661
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$89.23 |
| Max. Negotiated Rate |
$204.34 |
| Rate for Payer: Aetna Commercial |
$192.99
|
| Rate for Payer: Aetna Medicare |
$113.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.58
|
| Rate for Payer: BCBS Complete |
$90.82
|
| Rate for Payer: Cash Price |
$181.64
|
| Rate for Payer: Cofinity Advantage |
$158.94
|
| Rate for Payer: Cofinity Commercial |
$195.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$181.64
|
| Rate for Payer: Healthscope Commercial |
$204.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$181.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$192.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$170.29
|
| Rate for Payer: PHP Commercial |
$192.99
|
| Rate for Payer: Priority Health SBD |
$143.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$147.58
|
| Rate for Payer: UHC Core |
$118.29
|
| Rate for Payer: UHC Exchange |
$89.23
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$227.95
|
|
|
Service Code
|
NDC 70010002201
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$89.58 |
| Max. Negotiated Rate |
$205.16 |
| Rate for Payer: Aetna Commercial |
$193.76
|
| Rate for Payer: Aetna Medicare |
$113.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.17
|
| Rate for Payer: BCBS Complete |
$91.18
|
| Rate for Payer: Cash Price |
$182.36
|
| Rate for Payer: Cofinity Advantage |
$159.56
|
| Rate for Payer: Cofinity Commercial |
$196.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.36
|
| Rate for Payer: Healthscope Commercial |
$205.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$182.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$193.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$170.96
|
| Rate for Payer: PHP Commercial |
$193.76
|
| Rate for Payer: Priority Health SBD |
$143.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$148.17
|
| Rate for Payer: UHC Core |
$118.76
|
| Rate for Payer: UHC Exchange |
$89.58
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$225.60
|
|
|
Service Code
|
NDC 00245531611
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.66 |
| Max. Negotiated Rate |
$203.04 |
| Rate for Payer: Aetna Commercial |
$191.76
|
| Rate for Payer: Aetna Medicare |
$112.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.64
|
| Rate for Payer: BCBS Complete |
$90.24
|
| Rate for Payer: Cash Price |
$180.48
|
| Rate for Payer: Cofinity Advantage |
$157.92
|
| Rate for Payer: Cofinity Commercial |
$194.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.48
|
| Rate for Payer: Healthscope Commercial |
$203.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$180.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$169.20
|
| Rate for Payer: PHP Commercial |
$191.76
|
| Rate for Payer: Priority Health SBD |
$142.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$146.64
|
| Rate for Payer: UHC Core |
$117.54
|
| Rate for Payer: UHC Exchange |
$88.66
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$260.85
|
|
|
Service Code
|
NDC 00832532311
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$164.34 |
| Max. Negotiated Rate |
$234.76 |
| Rate for Payer: Aetna Commercial |
$221.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.55
|
| Rate for Payer: Cash Price |
$208.68
|
| Rate for Payer: Cofinity Advantage |
$182.59
|
| Rate for Payer: Cofinity Commercial |
$224.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.68
|
| Rate for Payer: Healthscope Commercial |
$234.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$195.64
|
| Rate for Payer: PHP Commercial |
$221.72
|
| Rate for Payer: Priority Health SBD |
$164.34
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$286.90
|
|
|
Service Code
|
NDC 00574027511
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$112.75 |
| Max. Negotiated Rate |
$258.21 |
| Rate for Payer: Aetna Commercial |
$243.87
|
| Rate for Payer: Aetna Medicare |
$143.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.49
|
| Rate for Payer: BCBS Complete |
$114.76
|
| Rate for Payer: Cash Price |
$229.52
|
| Rate for Payer: Cofinity Advantage |
$200.83
|
| Rate for Payer: Cofinity Commercial |
$246.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.52
|
| Rate for Payer: Healthscope Commercial |
$258.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$215.18
|
| Rate for Payer: PHP Commercial |
$243.87
|
| Rate for Payer: Priority Health SBD |
$180.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$186.49
|
| Rate for Payer: UHC Core |
$149.47
|
| Rate for Payer: UHC Exchange |
$112.75
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$282.15
|
|
|
Service Code
|
NDC 24979023101
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$177.75 |
| Max. Negotiated Rate |
$253.94 |
| Rate for Payer: Aetna Commercial |
$239.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.40
|
| Rate for Payer: Cash Price |
$225.72
|
| Rate for Payer: Cofinity Advantage |
$197.50
|
| Rate for Payer: Cofinity Commercial |
$242.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.72
|
| Rate for Payer: Healthscope Commercial |
$253.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$211.61
|
| Rate for Payer: PHP Commercial |
$239.83
|
| Rate for Payer: Priority Health SBD |
$177.75
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$265.55
|
|
|
Service Code
|
NDC 00245531601
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.36 |
| Max. Negotiated Rate |
$239.00 |
| Rate for Payer: Aetna Commercial |
$225.72
|
| Rate for Payer: Aetna Medicare |
$132.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.61
|
| Rate for Payer: BCBS Complete |
$106.22
|
| Rate for Payer: Cash Price |
$212.44
|
| Rate for Payer: Cofinity Advantage |
$185.88
|
| Rate for Payer: Cofinity Commercial |
$228.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.44
|
| Rate for Payer: Healthscope Commercial |
$239.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$212.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$199.16
|
| Rate for Payer: PHP Commercial |
$225.72
|
| Rate for Payer: Priority Health SBD |
$167.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$172.61
|
| Rate for Payer: UHC Core |
$138.35
|
| Rate for Payer: UHC Exchange |
$104.36
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$284.35
|
|
|
Service Code
|
NDC 72888007501
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$179.14 |
| Max. Negotiated Rate |
$255.91 |
| Rate for Payer: Aetna Commercial |
$241.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.83
|
| Rate for Payer: Cash Price |
$227.48
|
| Rate for Payer: Cofinity Advantage |
$199.04
|
| Rate for Payer: Cofinity Commercial |
$244.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.48
|
| Rate for Payer: Healthscope Commercial |
$255.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$213.26
|
| Rate for Payer: PHP Commercial |
$241.70
|
| Rate for Payer: Priority Health SBD |
$179.14
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$282.15
|
|
|
Service Code
|
NDC 24979023101
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.88 |
| Max. Negotiated Rate |
$253.94 |
| Rate for Payer: Aetna Commercial |
$239.83
|
| Rate for Payer: Aetna Medicare |
$141.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.40
|
| Rate for Payer: BCBS Complete |
$112.86
|
| Rate for Payer: Cash Price |
$225.72
|
| Rate for Payer: Cofinity Advantage |
$197.50
|
| Rate for Payer: Cofinity Commercial |
$242.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.72
|
| Rate for Payer: Healthscope Commercial |
$253.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$225.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$211.61
|
| Rate for Payer: PHP Commercial |
$239.83
|
| Rate for Payer: Priority Health SBD |
$177.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$183.40
|
| Rate for Payer: UHC Core |
$147.00
|
| Rate for Payer: UHC Exchange |
$110.88
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$286.90
|
|
|
Service Code
|
NDC 00574027511
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$180.75 |
| Max. Negotiated Rate |
$258.21 |
| Rate for Payer: Aetna Commercial |
$243.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.49
|
| Rate for Payer: Cash Price |
$229.52
|
| Rate for Payer: Cofinity Advantage |
$200.83
|
| Rate for Payer: Cofinity Commercial |
$246.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.52
|
| Rate for Payer: Healthscope Commercial |
$258.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$215.18
|
| Rate for Payer: PHP Commercial |
$243.87
|
| Rate for Payer: Priority Health SBD |
$180.75
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$227.05
|
|
|
Service Code
|
NDC 00904721661
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$89.23 |
| Max. Negotiated Rate |
$204.34 |
| Rate for Payer: Aetna Commercial |
$192.99
|
| Rate for Payer: Aetna Medicare |
$113.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.58
|
| Rate for Payer: BCBS Complete |
$90.82
|
| Rate for Payer: Cash Price |
$181.64
|
| Rate for Payer: Cofinity Advantage |
$158.94
|
| Rate for Payer: Cofinity Commercial |
$195.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$181.64
|
| Rate for Payer: Healthscope Commercial |
$204.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$181.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$192.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$170.29
|
| Rate for Payer: PHP Commercial |
$192.99
|
| Rate for Payer: Priority Health SBD |
$143.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$147.58
|
| Rate for Payer: UHC Core |
$118.29
|
| Rate for Payer: UHC Exchange |
$89.23
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$181.64
|
|
|
Service Code
|
NDC 60687081009
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.38 |
| Max. Negotiated Rate |
$163.48 |
| Rate for Payer: Aetna Commercial |
$154.39
|
| Rate for Payer: Aetna Medicare |
$90.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.07
|
| Rate for Payer: BCBS Complete |
$72.66
|
| Rate for Payer: Cash Price |
$145.31
|
| Rate for Payer: Cofinity Advantage |
$127.15
|
| Rate for Payer: Cofinity Commercial |
$156.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.31
|
| Rate for Payer: Healthscope Commercial |
$163.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$145.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$136.23
|
| Rate for Payer: PHP Commercial |
$154.39
|
| Rate for Payer: Priority Health SBD |
$114.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$118.07
|
| Rate for Payer: UHC Core |
$94.63
|
| Rate for Payer: UHC Exchange |
$71.38
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$225.60
|
|
|
Service Code
|
NDC 00245531611
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$142.13 |
| Max. Negotiated Rate |
$203.04 |
| Rate for Payer: Aetna Commercial |
$191.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.64
|
| Rate for Payer: Cash Price |
$180.48
|
| Rate for Payer: Cofinity Advantage |
$157.92
|
| Rate for Payer: Cofinity Commercial |
$194.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.48
|
| Rate for Payer: Healthscope Commercial |
$203.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$169.20
|
| Rate for Payer: PHP Commercial |
$191.76
|
| Rate for Payer: Priority Health SBD |
$142.13
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$227.95
|
|
|
Service Code
|
NDC 70010002201
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$143.61 |
| Max. Negotiated Rate |
$205.16 |
| Rate for Payer: Aetna Commercial |
$193.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.17
|
| Rate for Payer: Cash Price |
$182.36
|
| Rate for Payer: Cofinity Advantage |
$159.56
|
| Rate for Payer: Cofinity Commercial |
$196.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.36
|
| Rate for Payer: Healthscope Commercial |
$205.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$193.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$170.96
|
| Rate for Payer: PHP Commercial |
$193.76
|
| Rate for Payer: Priority Health SBD |
$143.61
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$2.87
|
|
|
Service Code
|
NDC 00574027500
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$2.58 |
| Rate for Payer: Aetna Commercial |
$2.44
|
| Rate for Payer: Aetna Medicare |
$1.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.87
|
| Rate for Payer: BCBS Complete |
$1.15
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cofinity Advantage |
$2.01
|
| Rate for Payer: Cofinity Commercial |
$2.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.30
|
| Rate for Payer: Healthscope Commercial |
$2.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.15
|
| Rate for Payer: PHP Commercial |
$2.44
|
| Rate for Payer: Priority Health SBD |
$1.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.87
|
| Rate for Payer: UHC Core |
$1.50
|
| Rate for Payer: UHC Exchange |
$1.13
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$260.85
|
|
|
Service Code
|
NDC 00832532311
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.51 |
| Max. Negotiated Rate |
$234.76 |
| Rate for Payer: Aetna Commercial |
$221.72
|
| Rate for Payer: Aetna Medicare |
$130.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.55
|
| Rate for Payer: BCBS Complete |
$104.34
|
| Rate for Payer: Cash Price |
$208.68
|
| Rate for Payer: Cofinity Advantage |
$182.59
|
| Rate for Payer: Cofinity Commercial |
$224.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.68
|
| Rate for Payer: Healthscope Commercial |
$234.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$208.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$195.64
|
| Rate for Payer: PHP Commercial |
$221.72
|
| Rate for Payer: Priority Health SBD |
$164.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$169.55
|
| Rate for Payer: UHC Core |
$135.90
|
| Rate for Payer: UHC Exchange |
$102.51
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$2.28
|
|
|
Service Code
|
NDC 60687081011
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$2.05 |
| Rate for Payer: Aetna Commercial |
$1.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.48
|
| Rate for Payer: Cash Price |
$1.82
|
| Rate for Payer: Cofinity Advantage |
$1.60
|
| Rate for Payer: Cofinity Commercial |
$1.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.82
|
| Rate for Payer: Healthscope Commercial |
$2.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.71
|
| Rate for Payer: PHP Commercial |
$1.94
|
| Rate for Payer: Priority Health SBD |
$1.44
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$2.28
|
|
|
Service Code
|
NDC 60687081011
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$2.05 |
| Rate for Payer: Aetna Commercial |
$1.94
|
| Rate for Payer: Aetna Medicare |
$1.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.48
|
| Rate for Payer: BCBS Complete |
$0.91
|
| Rate for Payer: Cash Price |
$1.82
|
| Rate for Payer: Cofinity Advantage |
$1.60
|
| Rate for Payer: Cofinity Commercial |
$1.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.82
|
| Rate for Payer: Healthscope Commercial |
$2.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.71
|
| Rate for Payer: PHP Commercial |
$1.94
|
| Rate for Payer: Priority Health SBD |
$1.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.48
|
| Rate for Payer: UHC Core |
$1.19
|
| Rate for Payer: UHC Exchange |
$0.90
|
|
|
POTASSIUM IODIDE 65 MG/ML ORAL DROPS
|
Facility
|
IP
|
$78.44
|
|
|
Service Code
|
NDC 00178031430
|
| Hospital Charge Code |
113247
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.42 |
| Max. Negotiated Rate |
$70.60 |
| Rate for Payer: Aetna Commercial |
$66.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.99
|
| Rate for Payer: Cash Price |
$62.75
|
| Rate for Payer: Cofinity Advantage |
$54.91
|
| Rate for Payer: Cofinity Commercial |
$67.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.75
|
| Rate for Payer: Healthscope Commercial |
$70.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.83
|
| Rate for Payer: PHP Commercial |
$66.67
|
| Rate for Payer: Priority Health SBD |
$49.42
|
|
|
POTASSIUM IODIDE 65 MG/ML ORAL DROPS
|
Facility
|
IP
|
$5.63
|
|
|
Service Code
|
NDC 09900001948
|
| Hospital Charge Code |
113247
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.55 |
| Max. Negotiated Rate |
$5.07 |
| Rate for Payer: Aetna Commercial |
$4.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.66
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cofinity Advantage |
$3.94
|
| Rate for Payer: Cofinity Commercial |
$4.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.50
|
| Rate for Payer: Healthscope Commercial |
$5.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.22
|
| Rate for Payer: PHP Commercial |
$4.79
|
| Rate for Payer: Priority Health SBD |
$3.55
|
|
|
POTASSIUM IODIDE 65 MG/ML ORAL DROPS
|
Facility
|
OP
|
$78.44
|
|
|
Service Code
|
NDC 00178031430
|
| Hospital Charge Code |
113247
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.83 |
| Max. Negotiated Rate |
$70.60 |
| Rate for Payer: Aetna Commercial |
$66.67
|
| Rate for Payer: Aetna Medicare |
$39.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.99
|
| Rate for Payer: BCBS Complete |
$31.38
|
| Rate for Payer: Cash Price |
$62.75
|
| Rate for Payer: Cofinity Advantage |
$54.91
|
| Rate for Payer: Cofinity Commercial |
$67.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.75
|
| Rate for Payer: Healthscope Commercial |
$70.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.83
|
| Rate for Payer: PHP Commercial |
$66.67
|
| Rate for Payer: Priority Health SBD |
$49.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.99
|
| Rate for Payer: UHC Core |
$40.87
|
| Rate for Payer: UHC Exchange |
$30.83
|
|
|
POTASSIUM IODIDE 65 MG/ML ORAL DROPS
|
Facility
|
OP
|
$5.63
|
|
|
Service Code
|
NDC 09900001948
|
| Hospital Charge Code |
113247
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.21 |
| Max. Negotiated Rate |
$5.07 |
| Rate for Payer: Aetna Commercial |
$4.79
|
| Rate for Payer: Aetna Medicare |
$2.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.66
|
| Rate for Payer: BCBS Complete |
$2.25
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cofinity Advantage |
$3.94
|
| Rate for Payer: Cofinity Commercial |
$4.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.50
|
| Rate for Payer: Healthscope Commercial |
$5.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.22
|
| Rate for Payer: PHP Commercial |
$4.79
|
| Rate for Payer: Priority Health SBD |
$3.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.66
|
| Rate for Payer: UHC Core |
$2.93
|
| Rate for Payer: UHC Exchange |
$2.21
|
|
|
POTASSIUM PHOS-MONO-DIBASIC 3 MMOL/ML (4.7 MEQ POTASSIUM/ML) IV SOLN
|
Facility
|
OP
|
$431.09
|
|
|
Service Code
|
NDC 46287002415
|
| Hospital Charge Code |
193046
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$169.42 |
| Max. Negotiated Rate |
$387.98 |
| Rate for Payer: Aetna Commercial |
$366.43
|
| Rate for Payer: Aetna Medicare |
$215.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$280.21
|
| Rate for Payer: BCBS Complete |
$172.44
|
| Rate for Payer: Cash Price |
$344.87
|
| Rate for Payer: Cofinity Advantage |
$301.76
|
| Rate for Payer: Cofinity Commercial |
$370.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.87
|
| Rate for Payer: Healthscope Commercial |
$387.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$344.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$366.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$323.32
|
| Rate for Payer: PHP Commercial |
$366.43
|
| Rate for Payer: Priority Health SBD |
$271.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$280.21
|
| Rate for Payer: UHC Core |
$224.60
|
| Rate for Payer: UHC Exchange |
$169.42
|
|
|
POTASSIUM PHOS-MONO-DIBASIC 3 MMOL/ML (4.7 MEQ POTASSIUM/ML) IV SOLN
|
Facility
|
IP
|
$431.09
|
|
|
Service Code
|
NDC 46287002415
|
| Hospital Charge Code |
193046
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$271.59 |
| Max. Negotiated Rate |
$387.98 |
| Rate for Payer: Aetna Commercial |
$366.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$280.21
|
| Rate for Payer: Cash Price |
$344.87
|
| Rate for Payer: Cofinity Advantage |
$301.76
|
| Rate for Payer: Cofinity Commercial |
$370.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.87
|
| Rate for Payer: Healthscope Commercial |
$387.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$366.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$323.32
|
| Rate for Payer: PHP Commercial |
$366.43
|
| Rate for Payer: Priority Health SBD |
$271.59
|
|
|
POTASSIUM PHOS-MONO-DIBASIC 3 MMOL/ML (4.7 MEQ POTASSIUM/ML) IV SOLN
|
Facility
|
IP
|
$431.09
|
|
|
Service Code
|
NDC 46287002410
|
| Hospital Charge Code |
193046
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$271.59 |
| Max. Negotiated Rate |
$387.98 |
| Rate for Payer: Aetna Commercial |
$366.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$280.21
|
| Rate for Payer: Cash Price |
$344.87
|
| Rate for Payer: Cofinity Advantage |
$301.76
|
| Rate for Payer: Cofinity Commercial |
$370.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.87
|
| Rate for Payer: Healthscope Commercial |
$387.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$366.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$323.32
|
| Rate for Payer: PHP Commercial |
$366.43
|
| Rate for Payer: Priority Health SBD |
$271.59
|
|
